Understanding Reactive Attachment Disorder


Reactive Attachment Disorder (RAD) is a rare but serious psychiatric condition in which an individual fails to develop healthy emotional attachments with caregivers or authority figures. The disorder is most commonly observed among children who have experienced severe neglect, abuse, trauma, or institutional care in infancy of early childhood. Children with RAD often experience developmental, emotional, and behavioral problems that can significantly impact their quality of life and relationships.

In this article, we delve into the symptoms, causes, diagnosis, and treatment of RAD to help readers understand the complexities of this disorder and how best to support individuals with its diagnosis.

Symptoms of Reactive Attachment Disorder

The symptoms of RAD manifest from a child’s inability to form healthy emotional attachments early in life. Children with RAD may exhibit the following behaviors:

  • Indifference or detachment to any affection or comfort from caregivers
  • Minimal emotional responses to others or to environmental stimuli
  • Lack of interest or disregard for social occurrences that typically elicit an emotional reaction (e.g., birthdays, family holidays)
  • Unresponsiveness to physical or verbal attempts to soothe or stimulate them
  • Frequent expressions of sadness or irritability
  • Excessive anger or aggression towards self or others
  • Difficulty understanding social cues and boundaries
  • Unusual behaviors such as hoarding food, excessive attachment to objects, or rocking

The symptoms of RAD may be similar to other childhood disorders like autism, depression, or anxiety. Therefore, a comprehensive psychological evaluation by a qualified clinician is necessary for proper diagnosis and treatment.

Causes of Reactive Attachment Disorder

The exact causes of RAD are not yet fully understood, but it is believed that early childhood experiences play a significant role in its development. Some factors that can lead to RAD include:

  • Experiencing neglect or constant changes of primary caregivers
  • Living in institutions, such as orphanages or group homes
  • Living in chaotic or abusive home environments
  • Early hospitalizations or prolonged stays in neonatal intensive care units (NICU)
  • Being separated from the biological mother during the first year of life

The early experiences of a child can shape their relational patterns with others, and when these experiences are disrupted, it can lead to the development of attachment difficulties.

Diagnosis of Reactive Attachment Disorder

Diagnosing RAD can be challenging, as it shares symptoms with other mental health disorders. A comprehensive assessment by a qualified mental health professional is necessary to eliminate any other alternative diagnoses.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) provides specific criteria for diagnosing RAD, which include the following:

  • A consistent pattern of emotionally withdrawn behavior towards caregivers or adult figures in the child’s life
  • The child rarely seeks or responds to comfort or assistance from caregivers or other adults
  • Minimal social and emotional responsiveness to social cues or interactions with others
  • The child has experienced a pattern of significant neglect or deprivation of basic needs since early childhood
  • The behaviors mentioned above are not attributable to developmental delays or other mental health disorders.

Treatment of Reactive Attachment Disorder

Effective treatment for RAD is possible when the disorder is detected and addressed early on. Treatment primarily involves therapy sessions that focus on developing healthier attachment relationships by teaching the child to trust, bond, and connect with others.

The following are some of the treatment options that may be used to manage RAD:

  • Attachment-Based Therapy: This is a unique form of therapy designed for children with attachment difficulties. It involves developing a close relationship between the child and a trusted adult, which can help the child develop healthy attachment skills.
  • Family Therapy: This therapy aims to strengthen the bond between the child and the family/caregivers. Family therapy educates family members and enhances their skills in responding to the child’s needs.
  • Behavior Therapy: Behavior therapy employs techniques such as positive reinforcement, shaping, and modeling to influence appropriate behavior in children with RAD.
  • Medication: There is no specific medication for RAD, but some psychiatric medications may be prescribed to manage additional symptoms such as anxiety or depression.

The treatment of RAD requires patience, consistency, and a team approach involving the child, family, mental health professionals, caregivers, and educators.


Reactive Attachment Disorder is a complex mental health disorder that requires early identification and proper treatment to prevent its long-term effects on children. Children who have experienced neglect, trauma, or institutional care in early life may develop RAD, leading to difficulty in forming healthy relationships, social isolation, and developmental issues. It is important to note that with early detection, proper diagnosis, and effective interventions, children with RAD have the opportunity to learn and develop the skills needed to form healthy attachments, relationships, and lead fulfilling lives.


What is Reactive Attachment Disorder?

Reactive Attachment Disorder (RAD) is a rare and serious mental health condition that occurs when an attachment between a child and their caregiver does not develop properly. It results in an inability for the child to form healthy relationships and can cause a range of emotional and behavioural problems.

What are the symptoms of Reactive Attachment Disorder?

Symptoms of RAD include a lack of interest in social interaction, unusual detachment, unresponsiveness to social cues, and a lack of desire for physical contact. Children with RAD may also demonstrate hostility, aggression, irritability, and difficulty showing affection.

How is Reactive Attachment Disorder treated?

Treatment for RAD typically involves therapy, such as play or talk therapy, to help the child form healthy attachments and improve their emotional and behavioural functioning. Early intervention is key, as children who do not receive appropriate treatment may experience long-term social, emotional, and behavioural difficulties. Additionally, caregivers may need support and guidance to better understand how to meet the child’s emotional needs.


1. Groze, V., & Iwaniec, D. (2008). Early attachment relationships and later development: Implications for intervention. Early Child Development and Care, 178(2), 177-189. doi: 10.1080/03004430600886961

2. Minnis, H., Marwick, H., Arthur, J., & McLaughlin, A. (2017). Reactive attachment disorder: A theoretical model beyond attachment. European Child & Adolescent Psychiatry, 26(10), 1101-1111. doi: 10.1007/s00787-017-0969-z

3. Schore, A. N. (2014). Early relational trauma and the developing right brain: An interface of psychoanalytic self psychology and neuroscience. Annals of the New York Academy of Sciences, 1159(1), 189-203. doi: 10.1111/nyas.12558